Bone Marrow Biopsy

What is a bone marrow biopsy?

A bone marrow biopsy is a procedure used to diagnose conditions affecting your blood and bone marrow. Your bone marrow is where your body’s blood cells get made. During the procedure, your healthcare provider removes a small sample of marrow from inside a bone. Afterward, a specialist called a pathologist examines the cells from the marrow under a microscope, looking for signs of disease.

Many conditions — including blood disorders and some cancers — require a bone marrow biopsy to confirm a suspected diagnosis.

What is bone marrow?

Bone marrow is located inside the hollow center of your larger bones. Bone marrow consists of soft, sponge-like tissue and a liquid.

The tissue part of bone marrow produces:

• Red blood cells: Cells that carry oxygen throughout your body.
• White blood cells: Cells that protect your body from germs and infectious diseases.
• Platelets: Cells that form clots to stop bleeding when your blood vessels are damaged. Your blood vessels are tubes like arteries, veins and capillaries that circulate blood throughout your body.

The liquid part of bone marrow contains stem cells, or maturing blood cells. It also makes vitamins needed for cell production.

While a bone marrow biopsy tests the tissue part of your bone marrow, a separate procedure called a bone marrow aspiration tests the liquid portion. On the day of your procedure, your provider will likely perform a bone marrow aspiration immediately before the biopsy.

When would a doctor order a bone marrow biopsy?

A bone marrow biopsy provides valuable information your provider can use to:

• Evaluate or diagnose a condition: Your healthcare provider might order a bone marrow biopsy if they notice an abnormal number of blood cells in a blood sample. A biopsy can help them diagnose blood disorders, cancer, causes of unexplained fevers or infections and more.
• Stage cancer: Cancer staging measures how much cancer has progressed. A bone marrow biopsy can show if cancer has spread to your bone marrow. It can show if a tumor in your bone marrow is growing.
• Monitor treatment progress: Your provider may perform a bone marrow biopsy to see if treatment is working. For example, you may receive regular bone marrow biopsies if you receive cancer treatments. The results can show if your bone marrow produces enough healthy blood cells after treatment.

A bone marrow biopsy can also determine whether a donor is a good match for an allogeneic stem cell transplant. In some instances, a person with too few healthy blood cells may need new, healthy stem cells from a donor. For this to happen, the cells from the donor and recipient must match.

What conditions and diseases are diagnosed with a bone marrow biopsy?

Your provider may perform a bone marrow biopsy to diagnose conditions involving too many or too few blood cells. Bone marrow biopsies may also be used to diagnose cancers affecting your blood or bone marrow.

Conditions include:

• Anemia: A condition that involves not having enough red blood cells to carry oxygen throughout your body.
• Aplastic anemia: A condition where your blood marrow can’t produce enough red blood cells, white blood cells and platelets.
• Leukopenia and leukocytosis: Conditions involving too few or too many white blood cells.
• Thrombocytopenia and thrombocytosis: Conditions involving too few or too many platelets.
• Polycythemia vera: A rare blood cancer that causes your blood marrow to produce too many red blood cells.
• Leukemia: Cancer of your blood cells that can lead to abnormal blood cells, especially white blood cells.
• Lymphoma: Cancer of your lymphatic system that can lead to an abnormal number of white and red blood cells.
• Multiple myeloma: A rare blood cancer that harms your plasma cells. A plasma cell is a type of white blood cell.
• Secondary cancers: Cancer that starts elsewhere in your body (for example, breast cancer or lung cancer) but then spreads to a secondary location, like your bone marrow.
• Myelofibrosis: A disorder involving fibrous scar tissue replacing bone marrow.
• Myelodysplastic syndrome: A bone marrow disorder in which stem cells don’t mature properly.

A bone marrow biopsy can also detect abnormalities in chromosomes and vitamin deficiencies, which can trigger your bone marrow to produce red blood cells that are misshapen or too large.

Who performs a bone marrow biopsy?

A provider specializing in blood disorders (hematologist) or cancer (oncologist) may perform your bone marrow biopsy. Nurses who are specially trained in this procedure also perform bone marrow biopsies.

How can I prepare for a bone marrow biopsy?

Your provider will explain the procedure and instruct you on how to prepare. For instance, if you receive a sedative to help with the pain the day of the procedure, you may need to fast (no food or drink) the night before. You’ll need to arrange for someone to drive you home.

Your provider should have detailed information about your medical history and current medications. Tell them about:

• Any history of bleeding disorders (such as hemophilia).
• Any medications you’re taking, especially blood thinners (anticoagulants).
• Any vitamins or supplements you’re taking.
• Any medication allergies.

Your provider will also need to know if you’re pregnant.

What should I expect during a bone marrow biopsy?

A bone marrow biopsy can occur in your healthcare provider’s office or hospital. The entire process lasts about 30 minutes. You’ll be awake during the procedure, but your provider will numb the biopsy site (local anesthesia) to keep you comfortable.

Before the procedure, you’ll change into a hospital gown. Your provider may give you a sedative to help you relax.

Typically, the steps are as follows:

1. Depending on the biopsy site, you’ll lie on your side or your belly. The most common bone marrow biopsy site is the back of your hip bone (posterior iliac crest).
2. Your provider will clean your skin with an antiseptic and inject a numbing medication through your skin to the bone surface.
3. They’ll make a small incision at the site and insert a special biopsy needle into your bone. They’ll use a small syringe attached to the needle to remove liquid from your bone marrow. This is called a bone marrow aspiration.
4. They’ll insert a needle with a hollowed-out center to capture a small piece of the sponge-like tissue from your marrow. This type of biopsy is called a core biopsy because the needle removes a “core,” or cylinder-shaped, tissue sample.
5. Your provider will remove the needle that contains the sample. They’ll apply pressure to your skin to stop any bleeding and place a bandage over the wound.

Your provider will send the sample to a lab, where it can be examined for signs of disease.

How painful is a bone marrow biopsy?

You may feel a sharp sting during the bone marrow aspiration, and you may feel brief, dull pain during the core biopsy part of the procedure. Unfortunately, bone can’t be numbed. You may feel pressure, pushing and pulling that may cause discomfort.

Talk to your provider about any concerns you may have about pain. In addition to numbing the biopsy site, they can provide medications to keep you more comfortable during your biopsy.

What should I expect after a bone marrow biopsy?

You’ll likely go home the same day of your procedure. If you received a sedative during the biopsy, you’ll need someone to drive you. Follow your healthcare provider’s instructions about caring for yourself as you recover.

They may advise you to:

• Take a nonprescription pain reliever to help with pain or discomfort.
• Avoid exercise or any strenuous physical activity for at least 24 hours.
• Keep your wound dry for at least 24 hours.

Are there risks to a bone marrow biopsy?

Complications, like heavy bleeding and infection at the biopsy site, are rare. Usually, applying pressure to the site stops excess bleeding. Your provider may prescribe an antibiotic cream if you get an infection.

What type of results do you get and what do the results mean?

A specialist called a pathologist will analyze your bone marrow sample underneath a microscope. Your provider will review the pathologist’s findings and share next steps with you. Your provider may confirm a diagnosis, order more tests, or recommend or adjust treatments depending on your results.

Ask your provider what your results mean for you.

When should I call my doctor?

Call your healthcare provider if you experience signs of a complication, including:

• Heavy bleeding or drainage from the biopsy site.
• Swelling from the biopsy site.
• Redness (especially if it spreads).
• Fever or worsening pain.

A note from Cleveland Clinic

A bone marrow biopsy may be necessary if you have signs of a blood disorder or another condition involving your bone marrow. Talk to your healthcare provider if you have specific questions about the procedure or concerns about the sensations you may feel during a biopsy. They can provide pain medication to keep you comfortable and relaxed. They can also talk you through each step of the procedure so you feel more informed and confident on your biopsy day.